A blog about poetry, literature, and art, that occasionally engages other issues of importance and interest.

Thursday, May 22, 2008

Speech After Long Silence

My recent extended absence from this blog, and from the Poetry Foundation's Harriet blog, has been due to severe illness (the worst of my life, including my colon cancer) and a long hospital stay.

The short version: I was in the hospital for over a month, and almost died during the first week. According to my infectious disease doctor, by the odds, and given everything that was happening to me at once, I should be dead.

The long version: Around April 14 I suffered a perforation of my small intestine which filled my abdominal cavity with unfriendly bacteria and led to a bad case of peritonitis, an inflammation of the intestinal tract. No one knows why or even exactly when the perforation occurred, so no one knows whether it might happen again, let alone how to keep it from recurring. The bacteria spread to my circulatory system, and I developed a nearly fatal case of septicemia, blood poisoning. I had three surgeries to clean out my abdomen over the course of ten days, including a resectioning that removed part of my small intestine (in addition to the portion of my colon that was removed in November along with my tumor) because it was irreparably infected. I was so swollen and distended that I couldn’t be fully closed up after the first two procedures, because the internal pressure would have been too great. Before the first operation, my blood pressure collapsed (to something like 40 over 20), I had a heart attack, and my kidneys briefly stopped functioning; immediately after the second procedure, as I was coming out of anesthesia, I had a seizure. For quite a while I was on a ventilator, because I couldn’t breathe on my own. The surgeon also discovered a bone fragment in my liver, probably the cause of some of my pain in that region.

I was unconscious or semi-conscious at most for all of this, so I have no memory of these events. I only know they happened because Robert (and my doctors) told me about them. Indeed, Robert knows more about what happened to me than I do, since he was there, while I wasn’t, at least not in any meaningful sense. I remember waking up at one point while Robert, who came to see me every day for as long as they would let him stay, was with me in the intensive care unit, and asking how long I’d been there. “Two weeks,” he replied.

That I could have died and not even known I was dying, not known that anything was happening at all, is terrifying to me, even more than the (quite terrifying in itself) knowledge that I almost died itself. There’s an element of adding primal insult to injury in the thought that my own death wouldn’t even be part of my experience, as if it weren’t mine at all.

For me, writing all this down has the dual and perhaps contradictory effect of simultaneously bringing these events closer and keeping them at a distance; it serves both to internalize and to externalize what happened to me. Writing something down, achieving the mental distance to give it shape and form, is a way to gain control over experience, rather than be overwhelmed by it. But I didn’t experience these things at the time; my knowledge of them is all after the fact. So writing this is also a way of making these experiences mine, of internalizing these events so that they become part of my experience. It makes them simultaneously more real (more mine) and less real (less crushing).

Illness is in general not interesting, though it is painful, time-consuming, and overwhelming, capable of taking over one's life. But some of the mind’s ways of coping with the body’s utter helplessness are fascinating. I was very heavily sedated for the first two weeks or so of my hospital stay, largely for my own protection—so that I wouldn’t, for example, try to rip the breathing tube out of my throat. (My wrists were in restraints for the same reason.) One strong effect of the sedation was to produce very vivid and often frightening hallucinations. At first, the hallucinations were distinct from reality, and I was often aware that I was in an hallucination. One involved playing a game based on the Disney animated series Kim Possible, about a high school cheerleader who also saves the world on a regular basis. I was on a high-speed train whose tracks were the ceiling tracks to which the hospital curtains were attached. If I could finish the game successfully, I would be able to escape the hallucination and get back to reality. But of course I couldn’t, so I was trapped. I had another hallucination that I was in the car with Robert (I could sense his presence but I couldn’t see or hear him—I spent a lot of time in my hallucinations looking for him, knowing that he was somewhere just out of reach), going from restaurant to restaurant all over town to compare their food, except that the windows were completely opaque and the car never moved. I was just stuck there, knowing that there was a world outside the car, but unable to reach it, though I could place orders for food I’d never get to eat or even see.

As I became more conscious, the hallucinations began to merge with the reality of my immersion in the intensive care unit. This was a bad thing, as the lines between hallucination and reality became more and more blurred, and I could never figure out whether something was real or a delusion. I became convinced that, as in some horror movie in which an autopsy is performed on a man who is paralyzed but still alive, the hospital and its staff were trying to kill me. Robert tells me that they would ask if I wanted any pain medicine (I was in constant agony) and I would shake my head in wide-eyed terror, fearing what they might inject me with. He’d then ask me and I’d nod yes. (I trusted him.) That they gave me the shots despite my refusals further convinced me of their evil intentions. When the nurse took out the breathing tube on which I’d been dependent, I accused her of trying to kill me. When she denied trying to suffocate me, I cried out (with a strength that apparently surprised everyone) “You lie!” When Robert pointed out fifteen minutes or so later that I was still alive, I considered the situation, and then replied, “Sometimes it takes a while to die.”

For much of this time I couldn’t even talk, because of the breathing tube down my throat (at times I was partially paralyzed, doubtless by all the sedation). Even when the breathing tube was taken out, I could only manage a few whispered, labored words before being overwhelmed by exhaustion. I got a clipboard and some paper from the nurses and would try to write messages like “Don’t kill me” and “I can speak,” but they just came out as scrawls and scribbles, because my limbs were so weak and atrophied.

As the days went by and I became more lucid, I would test my delusions to see whether I had gotten back to reality. I became more fully aware of Robert during his visits, which was a great relief—as I wrote above, I spent a lot of my time while unconscious searching for him. (Robert tells me that even when I was unconscious I would sometimes wake for a few seconds, and if he was there I would touch and even grab him, to make sure that he was real. Sometimes I almost choked him.) I remember one day in particular during which I felt a great sense of relief—“Okay, this is actually real”—until something happened (I can’t remember what) and I realized, “Oh no, I’m still in a delusion.” When the random patterns on the acoustic ceiling tiles stopped looking as if someone had covered the tiles with every possible word or phrase (in several languages) that began with the letter “I” (including every pop song title imaginable), then I knew I had finally returned to reality, though prior to that day there were several occasions on which I wanted to point out to Robert how clever how clever whoever had created that ceiling palimpsest was.

That, though, only takes me to about three weeks into my hospital stay, the rest of which was taken up with recovery and rehabilitation. And though I am finally at home, the road to wellness is long and winding. I have a large open wound along the entire length of my abdomen (it makes my colon surgery scar look like a little scratch), covered by a substantial dressing that must be changed by a registered nurse three times a week (a delicate and uncomfortable procedure). The wound is drained by a vacuum pump that is my newest and most indispensible fashion accessory; this must be detached and reattached each time the dressing is changed, and must provide an airtight seal. (The wound is apparently healing well—the nurses who’ve changed the dressing keep saying how “nice” it is.) And given the extent and intensity of my infections, I will be receiving daily intravenous antibiotic infusions into the foreseeable future—as of now, the medication has no stop date. Thanks to home health care, these are things that can be tended to in my own home. Thanks to a modicum of health insurance coverage, these are essentials to which I can actually (though just barely) afford access.

There is always the pain: dull, sharp, throbbing, stabbing, gradually building or suddenly overwhelming, ranging from the persistently uncomfortable to the excruciating. One day a physical therapist asked me, “Do you have pain?” I had to explain that the question isn’t whether I have pain, but how much pain, what kind of pain, and where. Even with the various painkillers I’ve been on continuously since my admission to the hospital, painkillers I’m now in the process of trying to wean myself from, since they’re addictive and also cause constipation of epic proportions, I’ve yet to have a day free of pain. It’s only recently that I’ve had any extended respites from pain. But though the pain subsides, it never entirely goes away. There is also the exhaustion brought on by the simplest household tasks, like walking from one room to another, due to the atrophying of my limbs after a month of lying in a very uncomfortable hospital bed. I spent a substantial amount of my time and energy in the hospital learning how to sit up again, how to stand again, how to walk again, regained skills which I now practice many times a day just going from one room to another in my house.

I don’t know how to end this piece, especially given that the story hasn’t ended—I don’t know how things will turn out, though I’m told that I’m healing well. Perhaps that optimistic note is the best place to stop.

I've been thinking of you a lot, Reginald, having guessed what your silence might mean. I'm grateful you're back and soon to be back in the saddle.

If you say that "illness is in general not interesting," and I have to agree—in general. If you ever feel up to reading a terrific novel about illness, though—physical, mental, spiritual—try Alan Lightman's The Diagnosis. The main character's crisis is a micro version of Western culture's macro crisis—which makes the exploration of illness especially resonant.

Those of us who follow you know that your silences may be signals of pain and trouble. To see your entry this am is a relief. But please know that we tune into your silences as well. And send best energies to you and Robert.

Reginald, thank you for articulating so beautifully the difficult terrain of serious illness. I hope you are healing more every day and feeling sustained by poetry as well as the love and care of those around you.

I was concerned when so long went by without a post and feared the worst. I'm glad to see that, despite everything, you're up to posting again. Please accept my best wishes for your continued recovery and my hope that nothing of this sort will occur again; you certainly don't need any more "interesting times" of this sort.

Reginald, I am relieved and more glad than I can say to see you back on the blog, and in writing form again, even if the rest of the way back up and out of the ordeal is long and arduous. But it's six days after the post: I hope that all is continuing well.Marilyn

To echo HD...To go where I love and am loved. And to draw strength from that. Tired you must be, yet you still draw out from your heart a piece of perfect prose! Kindest wishes to you for your recovery.

You're a hero for getting through this and being able to write so lucidly about it in your condition. I'll send a Buddhist prayer on your behalf. But it seems to me this writing is a most powerful kind of prayer.

hey Reggie, I'm glad you're back home and healing. When I was 20 (now 51) I spent 3 months in an ICU ward after a car accident, 4 abdominal operations (spleenectomy, partial pancreatectomy, duodenal patch, & ensuing abscesses, one of which had to remain open, as yours is). I was struck, reading your column, by how familiar the account of your delusional terrors sound to me. Though i didn't experience the same degree of paranoia concerning those around me, I was haunted, during my drug induced half-conscious periods, by fears that my life not only wasn't real but that it had never been real. I found, then, the pain of the healing period almost easy to bear in comparison, because at least I knew that my perception of reality was free of delusion (at least to my mind). That feeling of being deluded, and having been deluded, is the most terrifying I've ever experienced.

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About Me

Reginald Shepherd is the editor of The Iowa Anthology of New American Poetries (University of Iowa Press, 2004) and of Lyric Postmodernisms (Counterpath Press, 2008). He is the author of: Fata Morgana (2007), winner of the Silver Medal of the 2007 Florida Book Awards, Otherhood (2003), a finalist for the 2004 Lenore Marshall Poetry Prize, Wrong (1999), Angel, Interrupted (1996), and Some Are Drowning (1994), winner of the 1993 Associated Writing Programs’ Award in Poetry (all University of Pittsburgh Press). Shepherd's work has appeared in four editions of The Best American Poetry and two Pushcart Prize anthologies, as well as in such journals as American Poetry Review, Conjunctions, The Kenyon Review, The Nation, The New York Times Book Review, Ploughshares, Poetry, and The Yale Review. It has also been widely anthologized. He is also the author of Orpheus in the Bronx: Essays on Identity, Politics, and the Freedom of Poetry (Poets on Poetry Series, University of Michigan Press). Shepherd has received grants from the National Endowment for the Arts, the Illinois Arts Council, the Florida Arts Council, and the Guggenheim Foundation, among other awards and honors.